pneumonia - Nursing Case Study

Pathophysiology

• Primary mechanism: Pneumonia occurs when bacteria, viruses, or fungi enter the lungs, causing an infection. This leads to inflammation and swelling in the lung's air sacs, or alveoli. The alveoli may then fill with fluid or pus, causing difficulty in breathing.

• Secondary mechanism: The body's immune system responds to the infection by sending white blood cells to attack the pathogens. However, this can cause the alveoli to become more inflamed and filled with fluid, worsening the symptoms.

• Key complication: If pneumonia is not treated promptly, it can lead to respiratory failure. This is because the infection and inflammation can damage the lung tissue, making it hard for oxygen to reach the bloodstream. This can cause a number of serious health problems, including organ failure and septic shock.

Patient Profile

Demographics:

58, Female, Elementary School Teacher

History:

• Key past medical history: Occasional Asthma, No hospital admissions

• Current medications: Salbutamol Inhaler as needed

• Allergies: Shellfish, Penicillin

Current Presentation:

• Chief complaint: Mild cough and fatigue

• Key symptoms: Low-grade fever, occasional cough, mild fatigue, discomfort in chest

• Vital signs: Temperature 99.4°F, Pulse 80 beats per minute, Respiratory rate 16 breaths per minute, Blood pressure 120/80 mmHg, Oxygen saturation 98% on room air

Section 1

New Diagnostic Results:

Two days after the initial consultation, the patient's lab results from her sputum culture came back positive for Streptococcus pneumoniae, confirming the diagnosis of pneumonia. Her complete blood count (CBC) also showed a slightly elevated white blood cell count at 11,000 cells/mcL, indicative of an infection. The chest x-ray showed patchy infiltrates in the right lower lobe of her lung, which is typical in bacterial pneumonia.

Based on these findings, the healthcare provider prescribed a course of antibiotics, specifically azithromycin, given her penicillin allergy. The patient was advised to rest, maintain hydration, and use her Salbutamol inhaler as needed for her asthma symptoms. She was also instructed to monitor her symptoms closely, specifically her fever and cough, and to report any worsening of symptoms such as increased difficulty breathing or persistent high fever. The patient was scheduled for a follow-up in one week or sooner if her condition deteriorates.

These diagnostic results and prescribed interventions provide an opportunity for the nurse to educate the patient about the importance of adhering to the antibiotic course, recognizing worsening symptoms, and the need for rest and hydration in the recovery process. The nurse should also reassure the patient that, with proper management, she can recover completely from pneumonia without any serious complications.

Section 2

Initial Assessment Findings:

On the third day of antibiotic therapy, the nurse conducted a follow-up assessment. The patient reported a decrease in her cough and slight improvement in her breathing, but she was still experiencing a low-grade fever of 100.4°F. Her blood pressure was 120/80 mmHg, heart rate was 85 beats per minute, and respiratory rate was 20 breaths per minute. Her oxygen saturation was slightly decreased at 94% on room air. The patient was adhering to the prescribed antibiotic regimen and had been using her Salbutamol inhaler when needed.

The patient's vital signs and reported symptoms indicate that she is responding to the treatment, but not as expected. This calls for the nurse to contact the healthcare provider with an update on the patient's progress. She should raise concerns about the patient’s persistent fever and lowered oxygen saturation despite antibiotic therapy. This situation highlights the need for the nurse to use clinical reasoning to identify potential complications and to ensure that the appropriate steps are taken to modify the patient's treatment plan if necessary.

Section 3

New Diagnostic Results:

The nurse contacted the healthcare provider, who ordered a complete blood count (CBC) and a chest X-ray to further investigate the patient's persistent fever and slightly decreased oxygen saturation. The results of the CBC showed a slightly elevated white blood cell count of 11,000 cells/mm3, indicating a possible ongoing infection. The chest X-ray revealed a small area of consolidation on the lower lobe of the right lung, suggesting that the pneumonia might not be fully resolved.

These new diagnostic results suggest that the current antibiotic therapy might not be completely effective against the patient's pneumonia. The nurse will need to communicate these findings to the healthcare provider promptly. An adjustment in the antibiotic regimen or the addition of another therapeutic intervention may be necessary to fully resolve the infection and to prevent further complications. The nurse should also continue to monitor the patient's vital signs closely, particularly her temperature and oxygen saturation.

Section 4

Change in Patient Status:

Over the course of the next 24 hours, the nurse noticed a slight increase in the patient's temperature from 101°F to 102.1°F. Her oxygen saturation also dipped slightly from 94% to 92%, while remaining on 2L of supplemental oxygen via nasal cannula. The patient reported increased difficulty breathing and a persistent cough that has become more productive, with yellow sputum.

These changes in the patient's status warrant immediate attention and reporting to the healthcare provider. The increased temperature and productive cough with yellow sputum could indicate that the pneumonia is worsening, despite the current antibiotic treatment. The drop in oxygen saturation suggests that the patient's respiratory function might be further compromised. The healthcare provider may need to reassess the treatment plan and consider alternative interventions to better manage the patient's pneumonia. The nurse should continue close monitoring of the patient's vital signs and symptoms and provide appropriate supportive care, such as encouraging fluid intake and providing a comfortable resting position for easier breathing.

Section 5

Change in Patient Status:

The patient's condition continued to evolve over the next 48 hours. The nurse noted a further increase in the patient's temperature to 102.9°F. Oxygen saturation levels fell slightly more to 89%, despite an adjustment to 3L of supplemental oxygen via nasal cannula. The patient described an increased difficulty in breathing, with her cough persisting and accompanied by greenish, thick sputum.

These changes indicate that the pneumonia may be progressing, despite adjustments in the treatment plan. The elevated temperature and changes in sputum color and consistency, along with the drop in oxygen saturation, suggest the possibility of a bacterial infection. This new development necessitates immediate notification of the healthcare provider, who may need to reassess the treatment strategy and possibly order new diagnostic tests. The nurse will continue to closely monitor the patient's vital signs, symptoms, and respiratory status, while providing necessary supportive care, such as fluid administration, oxygen therapy, and patient positioning for comfort and improved breathing.